Philippines Eye Screening Medical Mission

Growing up I was always told, 'we have it so easy in Australia'. I hadn't quite grasped a true appreciation for the health care systems we have accessible to us here in Australia until having the opportunity to be involved in an eye screening medical mission in the Philippines.

In 2015, I was sponsored as a final year Orthoptics student to be apart of an incredible initiative by the Rotary Club of Canterbury and Cataract Foundation to travel to the Philippines and perform eye assessments. One of the main examinations I was involved in was the grading of cataracts to help determine eligibility for cataract surgery. These operations were completed by two very inspirational Ophthalmologists who gave up their time and expertise to help reverse preventable blindness and give back quality of life to communities with a very low socio economic status.

Quick facts about the Philippines:

  • Comprised of 7,100 islands with a population of over 100 million
  • One of the most underdeveloped countries in Asia, many living below the poverty line
  • Estimated total vision impairment of approximately 2.6 million citizens

Main causes of vision impairment in the Philippines:

  • Cataracts - clouding of the natural lens in the eye
  • Uncorrected refractive error - long/short sighted, astigmatism
  • Pterygium - fibrovascular growth on front of eye
  • Glaucoma - eye pressure that causes damage to the optic nerve
Over half a million people in the Philippines are blind and among adults the leading cause is advanced cataracts.

Okay, so firstly what really is a cataract and secondly why are they so prominent in the Philippines?
We all have a natural lens inside our eye that allows light to pass through to the back of the eye and this aids with focussing. A cataract is when the natural lens in the eye becomes cloudy and prevents light from entering the eye. This can cause symptoms such as blurry or foggy vision and glare which is unable to be managed conservatively with glasses any further. Cataracts are in fact a normal ageing process of the eye - so yes we are all going to get cataracts are some stage, some people earlier than others.
The underlying reason as to why individuals in the Philippines develop cataracts at a much higher capacity is because of the excessive UV exposure. Due to the lack of education in these low socio-economic areas many people don't understand the importance of wearing sunglasses. Part of our education to patients was how crucial it is to wear sunglasses to protect their eyes from the excessive UV light and help slow down the progression of cataracts. We actually provided 160 free sunglasses to patients that did not have possess a pair.
Cataracts in most cases are a reversible blindness, so the opportunity to have surgery can transform the quality of life of a patient immensely. To witness the transition of a patient from being unable to work and almost totally dependent on extended family, to being independent and a productive member of society was extremely fulfilling.

Map of Masbate Island screening locations
The mission targeted various low socio-economic locations on the island of Masbate. We began in Bantique, a small island that was only reachable by boat from the main island.

I remember finding it difficult to come to terms with the fact that people had travelled for hours that morning to get their eyes assessed by us and many had never experienced an eye test before. Around 95% of the Ophthalmologists in the Philippines are located in the capital city, Manila. So as you can imagine the access to eye healthcare on the island of Masbate is extremely limited.

We also screened for cataracts in Balud, Mandaon, Baleno, Uson and the Masbate City Centre.

The first day of screening I almost fainted and I've never been a fainter. The conditions in which we were screening were like nothing I had ever experienced. Just imagine a run down old church with a massive line of people outside waiting for an eye test. It was extremely hot with minimal ventilation and it took a minimum of three people to assess one patient. Each station set up would have an Orthoptist, a Filipino language interpreter and a rotary volunteer who would record vision measurements and clinical findings.
Example of the recording sheet used to triage patients ^^
We had specific criteria in order to triage patients, for instance if they were able to achieve a functional level of vision then we would deny them eligibility for surgery, however if the cataract was visually significant and causing severe vision impairment we would refer the patient straight to the Ophthalmologist for surgery. If a patient showed a potential for improvement of vision with glasses we would refer to a local Optometrist on sight.

It was extremely challenging when I first began the eye screening process to determine if a cataract was considered dense enough to warrant surgery. I believe this is because in Australia we are able to detect and treat cataracts at a much earlier stage. It's a difficult concept to accept that we had to turn away so many people with poor vision due to advanced cases that had priority for surgery. I always had in the back of my mind the reality that if they lived in Australia many of the cases I declined for surgery would have been a good candidates to proceed with surgery in Australia. For me this was a huge struggle to accept but I had to keep remembering that we were giving help to as many people as we had the capacity and resources to.

Eye screening
More challenges I was faced with included conducting eye assessments out in the elements of broad daylight and finding it almost impossible to attain a red reflex (view of inside of the eye) and we definitely didn't have the time or the resources to instil mydriatic drops (pupil dilating drops to assist looking inside the eye). So when it came to identifying a cataract dense enough for surgery we relied on listening to patient symptoms carefully and vision measurements. Other difficulties I was confronted with included the language barrier, the enormous volume of patients and examination locations which as you can see from the image above was outside a hospital beside a tree for one of the screening locations.

In surgery observations with one
of the Ophthalmologists
On the second last day of volunteering after we had finished screening patients for the day we were invited to observe the Ophthalmologists performing cataract surgery. As we entered the theatre room the nurses asked that we take our shoes off. Yes, we were bare foot in theatre. This was a huge contrast to the surgery observations I had completed in Melbourne where we were completely gowned up and sterile. In other words it would be completely out of the question to not have any footwear on in a cataract surgery in Australia. The eye surgeons were incredibly enthusiastic about sharing their expertise in cataract surgery. I remember feeling overwhelmed at witnessing how generous and happy these Ophthalmologists were to be apart of the medical mission. In the surgery room they had music playing and they were singing in between patients being wheeled in for their surgery. It's a surgery observation I will never forget.

The challenges I faced during my time in the Philippines seem insignificant when you look at the results of the medical mission. The total number of people screened during the project was 1,600 along with 130 voluntary cataract surgeries.

My perceptions of accessibility to health care as well as my outlook on life completely changed from this experience. I am now much more appreciative of 'how easy we have it in Australia'. It's a feeling like no other knowing you have contributed to giving back sight, I can honestly say that volunteering to help combat preventable blindness in a third world country is such a touching journey. 

Eye'm out,



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